Brainstem Anesthesia and Cardiac Arrest Following Peribulbar Block: A Case Report and Systematic Review of the Literature.

Background

We report a case of brainstem anesthesia (BSA) and subsequent cardiac arrest following a routinary peribulbar block (PB) in a patient scheduled for cataract extraction and intraocular lens (IOL) implantation, thus providing a reference for further analysis of this potentially catastrophic life-threatening complication and to evaluate the current knowledge in terms of incidence, physiopathology management, and treatment of the BSA following PB.

Methods

Three databases (PubMed, Embase, and Scopus) were checked to perform a systematic review of all available studies in the English Language following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate relevant studies that clearly described BSA following BSA.

Results

Our literature search identified 15 cases. All the patients experienced BSA-related symptoms, including respiratory arrest, seizure, heart rate, and blood pressure abnormalities. All the patients with respiratory arrest required assisted ventilation with intubation, whereas patients with seizures were administered intravenous midazolam. Only one patient experienced cardiac arrest and underwent cardiac resuscitation. Surgery was aborted and deferred in 5 out of 15 patients, whereas 4 out of 15 underwent surgery after extubation.

Conclusions

Despite the BSA incidence after the PB being very low, this possible life-threatening rare event should be considered in patients losing their consciousness and becoming apneic after the block. Therefore, prompt recognition and immediate treatment are paramount to cope with this potentially catastrophic scenario and save the patient's life.